India is an ethnically and linguistically diverse country. It is also variable in terms of socio-economic and development indicators. Moreover the federal structure stipulated in the Indian constitution makes health care predominantly a state-level responsibility. As a result, depending on the economic prosperity, dominant political ideology, and even some cultural factors, access to healthcare varies across individual states. Given the breadth of diversity of Indian demographics, picking merely one group for analysis is a challenging endeavor. This is so because demographic groups in India intersect across language, caste, gender and class lines. When we apply these parameters to the Indian population we get thousands of small groups with marked differences between them in terms of privilege and quality of life. As a result no one group can be said to directly relate and represent India and its healthcare system. In order to overcome this challenge, the biggest minority group in the country is chosen, namely, women.
It is often pointed out by social scientists that women in India comprise the largest minority community. This ‘minority’ status has two key aspects – one figurative (that they are not empowered) and the other literal (they are only 49% of the total population). One of the anomalies regarding Indian demographics is the skewered sex-ratio. Country-wide statistics show that for every 49 females there are 51 males. This is a significant disparity in a population of more than 1.2 billion. One of the main reasons for this situation is a culturally promoted preference for boys over girls. As a consequence thousands of female fetuses are aborted annually, some even at advanced stages of pregnancy. This also puts the life of the mother at risk. It is not surprising then that India (especially the rural regions) score poorly in terms of maternity health parameters. Equally, rural India fares rather poorly on child nutrition and infant mortality counts. For healthcare providers the challenge is clear cut. The success of any healthcare initiative is pivoted on its effectiveness in improving quality of healthcare for women, and by extension children. (Ridge, 2010, p.1)
On top of the diversities in politics, economy and socio-culture, the geography and climate of the Indian subcontinent is also very diverse. This means that there cannot be a nation level one-size-fits-all approach to offering health care to women. Indeed, each of the Indian states (or provinces) has a different track record in providing healthcare for women. Among the 30 odd Indian States, Kerala, Himachal Pradesh and Tamil Nadu rank high in terms of access to public health care for this demographic group. There are some uniting undercurrents between the successful states. For example, states like Kerala and Tamil Nadu have had strong presence of socialist political parties. These parties have always exerted pressure toward implementing social welfare schemes, some of which were women centric. The fact that Tamil Nadu had elected a woman as its Chief Minister (J. Jayalalitha) is another important factor. In contrast, in most of the other states, public health care is either of poor quality or nearly nonexistent. (Kumar, 2007, p.160)
During the last 20 years two significant demographic shifts have happened in India. Both these shifts have implications for women’s access to healthcare. The first is urban migration. As the national economy moved away from predominantly agrarian toward industrialization, metropolitan hubs became commercial centers. This meant most organized jobs were only available in major cities, leading to an influx of workers from rural India. Indeed, in the last 20 years, apart from major metropolitan cities like Chennai, Delhi, Bangalore, Kolkata, Mumbai, Hyderabad, etc, many second-tier cities have considerably grown in size. This trend has implications for the healthcare industry, especially the services directed toward women. For example, since most urban dwellers work in the organized sector – mostly for a private or public corporation – their health insurance costs are mostly recovered through their salaries. This facilitates tie-ups with established healthcare providers for covering the healthcare needs of the worker and his/her dependants. It also means that the employer signs periodical subscription with private healthcare providers for employees en masse. There are advantages and disadvantages with this system. On the positive side, it brings efficiency and standardization to healthcare availability and dispensation. On the negative side, the coverage usually includes only common or regular health issues and excludes rare disorders. Moreover, the proportion of women in the workforce is considerably lower to that of men. This means that most of their access to private healthcare happens as dependants on their husbands’ insurance policy. For rural women, even this indirect route of access to quality healthcare is not available.
An interesting feature of Indian demographic trend is the dropping average age of the population. India’s population continues to grow geometrically past the one billion mark. This means that youth comprise a disproportionately high percentage of its total population. This is best illustrated by a statistic from the recently concluded general elections. Nearly 35% of the electorate is between the age group of 18-35. And the demographic group between 0-18 represents an even bigger share. In terms of healthcare, the services required by young women are quite distinct to that of elderly women. Healthcare in India for the latter group is in a sorry state. Given that India’s population is relatively young currently, it is not surprising that specialized healthcare for the elderly has not evolved here. Terms like palliative care are rarely heard or applied. Usually, the young are more vulnerable to one-off bouts of infections or diseases, whereas the older tend to have greater instances of chronic illnesses. Given the divergent healthcare needs of these two groups, policy makers face the tough task of balancing their competing claims. (Population Briefs, 2014, p.15)
Women’s health has a cascade effect on child health. In this respect, one of the recent success stories of the Indian healthcare system is the eradication of polio. For several decades, this endemic had been a bane for lower strata of society. The polio causing virus thrives in environments of low hygiene. As a result, it has mostly affected poverty-stricken housing colonies across India. In terms of scale, the polio had caused deformities and acute suffering to hundreds of thousands of babies and their families. The ability of the Indian government to bring this blight to a halt this year is a commendable effort. When we consider that the Indian population is more than one billion and it has a sprawling geography, the scale of this feat becomes apparent. (Ridge, 2010, p.1)